Getting your mid-sized practice designated as a credentialing delegate with commercial payers means you can eliminate payer plan enrollment delays, get paid faster, and avoid re-enrollment disasters.
Payers want to hand off provider credentialing and re-credentialing to you, but you must have specific processes in place to qualify. Being a delegate gives you control to enroll new providers into your payer plans almost immediately (so you get paid right away) and ensures that your current providers maintain enrollment without interruption.
The key is knowing how to set up and maintain your delegation process. This is where credentialing expert, Amy M. Niehaus, CPMSM, CPCS, MBA, can help. During her 60-minute online training, Amy walks you through how to set up your own delegation program and provide you with proven strategies to manage it seamlessly and successfully.
Here are a just a few of the step-by-step delegation program set up and maintenance strategies you’ll receive by viewing this 60-minute online training:
- Pin down what payer contract delegation clauses really give you control of
- Determine which NCQA rules you need to implement to comply
- Reduce time to conduct primary source verifications
- Uncover hidden terms in your delegate contract that can cause you problems
- Pinpoint who to include in your credentialing committee, and what they really do
- Master what constitutes a clean file, and why it’s so important
- Set up re-credentialing cycles that keep your providers enrolled, and you compliant
- Identify key documentation points that help you master a program audit
- Illustrate your quality with payer notifications and appeal processes
- Decide on the best method to manage your roster files to ensure top quality
- And so much more…
IMPORTANT: This is NOT a “how to” on credentialing providers. This session is a how-to on setting up and maintaining a delegation program. Attendees must have a good understanding of credentialing activities within a healthcare or physician organization to gain the biggest benefit from this session.
Implementing a successful delegate program doesn’t have to be a headache. With a little help, you can take control over your payer activation dates, your new providers get enrolled sooner, re-enrollment is managed more accurately, and your claim payments stop getting delayed for credentialing problems.
Amy has over 25 years’ experience in the areas of accreditation, regulatory compliance, credentialing, process simplification/re-design, credentialing technology, CVO development/certification and delegation.
She has developed and presented various programs on credentialing and privileging processes, TJC, NCQA and URAC accreditation standards, and delegation and is the author of the recently published book, “Credentialing for Managed Care: Compliant Processes for Health Plans and Delegated Entities.”
Amy has been a National Association Medical Staff Services (NAMSS) member since 1991, became CPMSM certified in 1992 and received her CPCS certification in 2002. She is a NAMSS instructor and previously served as Chair of its MCO Task Force and Education Committee.
She is a former President of the Missouri Association Medical Staff Services and its Greater St. Louis Area Chapter. She holds a Bachelor’s of Science degree from the University of Missouri and a Master’s degree in Business Administration from Maryville University in St. Louis.